Memtsa, Maria;
(2024)
Variations in the organisation of
Early Pregnancy Assessment Units in the UK
and their effects on clinical, service and
patient-centred outcomes:
FINDINGS FROM THE VESPA STUDY.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Early Pregnancy Assessment Units (EPAUs), that provide care for women with early pregnancy complication, operate in most UK acute hospitals. Strong evidence on their optimal configuration balancing cost-effectiveness, clinical, service and patient-centered outcomes has been lacking, and was identified as a research priority by NICE. Objectives: The primary aim of the study was to test the hypothesis that, in EPAUs with high consultant presence, the rate of hospital admissions for early pregnancy complications is lower than in units with low consultant presence. The key secondary objectives were: to assess the effect of increased consultant presence on other clinical outcomes, to explore patient satisfaction with the quality of care and to make evidence-based recommendations about the future configuration of EPAUs in the UK. Methods: The VESPA study employed a multi-methods approach including: prospective cohort study of women attending EPAUs to measure clinical outcomes, economic evaluation, patient satisfaction survey, qualitative interviews with service users, EPAU staff survey, and hospital emergency care audit. The study was conducted in 44 EPAUs across the UK and pregnant women attending the participating EPAUs or other hospital emergency services because of suspected early pregnancy complications took part in the study, as well as staff members directly involved in providing early pregnancy care. Findings: There was no evidence of an association between admission rate and consultant presence (p=0.497). The study showed that consultant presence in the EPAU has no significant impact on key outcomes such as proportion of women who are admitted to hospital as an emergency, PUL rates, new to follow up ratio, negative laparoscopy rate and patient satisfaction. All data strands indicated that smaller units run by senior or specialist nurses and supported by sonographers and consultants may represent the optimal EPAU configuration in terms of quality of care, cost effectiveness and patient satisfaction.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Variations in the organisation of Early Pregnancy Assessment Units in the UK and their effects on clinical, service and patient-centred outcomes: FINDINGS FROM THE VESPA STUDY |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Reproductive Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10196437 |
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